I do hereby authorize Boston
homestay Inc., to charge $__________ to the above VISA/MasterCard Account for
homestay placement services.
I agree to notify Boston Homestay Inc. directly should I have any intention of
extending my homestay beyond the agreed upon date. Furthermore, I authorize Boston Homestay to charge
my credit card at the agreed upon weekly/monthly rate should I decide to extend
my homestay, or return back to this homestay, for any reason.

Signature: ___________________________________, Date: _________________
(required when returning form by fax)